Correlation Of Serum Bilirubin And Malondialdehyde Levels With Glucose Metabolism And Adverse Pregnancy Outcomes In Patients With Gestational Diabetes Mellitus

Objective: To observe the changes of serum bilirubin levels in patients with gestational diabetes mellitus(GDM)and to explore the relationship between the levels of bilirubin and malondialdehyde and glucose metabolism and adverse pregnancy outcomes in GDM patients.Methods : The electronic case system collected 100 pregnant women with gestational diabetes mellitus who gave birth on June 1,2017,solstice,and August 31,2018 were in the GDM1 group,and 100 normal pregnant women in the same period were in the NGT1 group.In addition,30 cases of gestational diabetes diagnosed by OGTT test in the obstetrics clinic on February 1,2018 and 30 cases of pregnant women in the normal pregnancy group were diagnosed as GDM2 group,and 30 cases of pregnant women in the normal pregnancy group were diagnosed as NGT2 group.In the second trimester(24-28 weeks of pregnancy),tests of bilirubin,malondialdehyde and synchronous insulin release experiment were performed.All cases were selected in strict accordance with the inclusion and exclusion criteria of this study.General data of all pregnant women were collected,including height,pre-pregnancy and pre-delivery weight,pregnancy number,pregnancy outcome,early,middle and late pregnancy,serum bilirubin,glucose metabolism and other biochemical indexes.The pregnant women's insulin resistance index and their body mass index before pregnancy and delivery were calculated.SPSS software was used to analyze the data.Results: 1.The levels of serum total bilirubin and direct bilirubin in the GDM1 group were both low and those in the normal pregnancy NGT1 group.The levels of these two kinds of bilirubin in the GDM1 group and the NGT1 group were all shown as early pregnancy > late pregnancy > mid pregnancy(P < 0.05).There was a negative correlation between total bilirubin and glycosylated hemoglobin in early pregnancy(P < 0.05),but no correlation between total bilirubin and glucose tolerance.The levels of direct bilirubin,total bilirubin in early pregnancy were negatively correlated with glucose tolerance and glycosylated hemoglobin(P < 0.05).2.GDM2 group of patients in total bilirubin,direct bilirubin levels and adverse pregnancy outcomes compared with NGT2 group of pregnant women have no difference(P > 0.05),but the malondialdehyde GDM2 group,insulin resistance index is higher than the NGT2 group,the difference was statistically significant(P < 0.05),and in patients with GDM2 group,serum total bilirubin and malondialdehyde,insulin resistance index into negative correlation,statistically significant(P < 0.05).Serum total bilirubin,malondialdehyde levels and insulin resistance index were correlated with adverse pregnancy outcomes in GDM2 patients,with statistical significance(P < 0.05).Conclusion:1.There are strong levels of oxidative stress and insulin resistance in patients with gestational diabetes mellitus.2.Serum bilirubin levels in patients with early,middle and late gestational diabetes were lower than those in normal gestational diabetes,and both groups had the lowest bilirubin levels in the second trimester.Bilirubin levels may play an auxiliary role in the evaluation of gestational diabetes.3.Serum bilirubin is negatively correlated with malondialdehyde and insulin resistance index,all of which are correlated with adverse pregnancy outcomes of gestational diabetes mellitus.However,whether bilirubin can be used as a quantitative indicator of oxidative stress to predict adverse pregnancy outcomes remains to be further studied.